It’s Medicare open enrollment season, which means it’s also Medicare scam season. Eligible beneficiaries have until‍ Dece‍mber ‍7 to shop for the best deals for their health care dollar. Unfortunately, some of the offers won’t be deals at all. Here’s how to avoid the scams this open enrollment season. How It Works • The Medicare Open Enrollment Period runs from Octo‍ber 1‍5 to Dece‍mber ‍7‍. During this time, Medicare recipients can explore other health plans. • Because plans change from year to year, beneficiaries can save money by exploring different coverage options. • However, Medicare scams spike during open enrollment season, with bogus offers from real or impersonated insurance providers pitching free gifts or limited time offers. • Scammers also call Medicare beneficiaries claiming to be from Medicare, asking them to verify their information to issue a “new” card. What You Should Know • These scams are designed to capture personal information that can be used to bill Medicare fraudulently. • Criminals use free offers to entice people. From cheap giveaways to promises of free medical supplies, these tactics seek to harvest Medicare information or even a credit card number for alleged shipping charges, for instance. Unscrupulous salespeople may also try to pressure you to buy often worthless supplemental insurance products that will supposedly save thousands. Know that Medicare will never call you out of the blue. Criminals use “spoofing” technology to make it look like their incoming calls are coming from Medicare, so your caller ID is not trustworthy. Medicare is not sending out new cards; anyone suggesting otherwise is lying to you. What You Should Do Beneficiaries can compare plans safely and change their enrollment by going to www.medicare.gov or by calling 80‍0-‍63‍3-‍42‍27. Also, every state has a State Health Insurance Assistance Program (SHIP) with counselors who can help answer your questions. • Be suspicious of unsolicited offers, offers that are exceedingly generous and offers for free products in exchange for your personal information.

What to eat or drink to build a stronger defense this winter

The saying “you are what you eat” applies to your entire body, but it’s especially important when it comes to your immune system during flu season. “As we get older, our immunity starts to decline, but if we get the right nutrients, we can help our immune systems do their jobs to protect us against viruses like the flu,” says Samantha Heller, a New York City nutritionist.

You can keep it in tip-top shape during this flu season — which may be a doozy — if you focus on a plant-based diet rich in whole unprocessed foods, Heller says. One of the best eating patterns to illustrate this is the Mediterranean diet, which is rich in fruits, veggies, whole grains, nuts, beans and healthy fats such as fatty fish and olive oil. A study published in March in the journal Frontiers in Nutrition found that people who followed this diet were less likely to become infected by or die from COVID-19, suggesting it may provide an immune system boost that could protect you from other viral infections, too.

Here, more immunity boosting foods that research, and nutritionists, recommend for right now.

1. Green tea

Whether these particular tea leaves can really fend off the flu has been a source of debate among health researchers for years. But a new meta-analysis published in July in the journal Molecules looked at more than eight studies involving more than 5,000 participants to conclude there really is ample evidence to believe the beverage — and specifically, the catechins that provide its antioxidant power — can help your immune system fend off influenza.

2. Sweet potatoes

They’re a great source of beta carotene, a phytonutrient that helps your body make vitamin A. “It supports respiratory health by increasing the number of immune cells in the body,” explains Anna Taylor, lead outpatient clinical dietitian at the Cleveland Clinic’s Center for Human Nutrition. This is especially important for older adults, as our bodies make fewer immune cells as we age, she adds. Instead of cooking them with butter or brown sugar, Taylor recommends that you roast them with olive oil, oregano and black pepper. “You’ll get additional benefits from the spices, but you’re not loading up on sugar and saturated fat, both of which suppress your immune system,” she says.

3. Berries

They’re a rich source of vitamin C, which stimulates production of infection fighting white blood cells, Taylor says. A 2018 review of studies found that berries increased levels of disease fighting cells in older adults, such as natural killer cells and T-cells. They also contain flavonoids, substances that have antioxidant properties and protect all your cells — including your immune system cells — from damage, she adds. It’s so easy to incorporate them into your diet: ”Add them to your morning yogurt or oatmeal, or even cook them and throw them on your French toast instead of maple syrup,” Taylor recommends.

4. Beans

Chickpeas, black beans, kidney beans, they’re all rich in vitamin B12, a nutrient many older adults are low in, Heller says. “People over the age of 50 don’t absorb vitamin B12 as well in their body, but your immune system needs it to fight disease and repair damaged cells to keep you healthy,” she explains. They’re also high in zinc, which helps boost your body’s production of white blood cells, Taylor says. “Zinc deficiency has been linked to immune system dysfunction,” she says. Taylor recommends at least a half a cup of cooked beans three times a week. You can throw them into soups, chili, salads or even rice dishes. For a healthy crunchy snack, roast chickpeas in some olive oil.  

5. Nuts and seeds

These foods are rich in vitamin E, which plays a key role in your immune system by supporting the growth of T-cells, says Lauri Wright, chair of the Department of Nutrition and Dietetics at the University of North Florida. They’re also a good source of omega-6 fatty acids. Walnuts are an especially good choice, as research shows they have a very positive effect on your gut microbiome, says Kate Cohen, a registered dietitian nutritionist with the Ellison Institute for Transformative Medicine at Providence Saint John’s Health Center in Santa Monica, California. They also have more alpha-linolenic acid — an essential fatty acid important for immune function — than any other type of nut.

6. Salmon

It’s not plant-based, but it is one of the few foods that provides vitamin D, which plays a huge role in regulating your immune system, says Jennifer McDaniel, owner of McDaniel Nutrition Therapy in Clayton, Missouri. A 2020 study published in the journal JAMA Network Open found that people who had untreated vitamin D deficiency were almost twice as likely to test positive for COVID-19 as patients who had sufficient levels of the vitamin. A 6-ounce salmon filet has about 600 IU of vitamin D, which is close to the 800 IU that is recommended for people 70 and older. Another bonus: It’s rich in omega-3 fatty acids, which have also been shown to strengthen your immune system.

If you’re not a fan of fish, McDaniel suggests marinating it in brown sugar and Dijon mustard for 45 minutes, then throwing it on the grill. “It mellows out that fishy taste, and it gives it a smoky flavor,” she explains. Canned salmon counts, too: Throw it over a salad for a quick meal, she says. 

7. Garlic

It’s rich in a compound called alliin, which may be the source of its immune boosting properties, notes Libby Mills, a Philadelphia nutritionist and spokesperson for the Academy of Nutrition and Dietetics. A 2020 review published in the journal Medical Hypotheses found that garlic itself seems to stimulate cells related to immune system function. Another study published in the Journal of Nutrition found that people given about 2½ grams of aged garlic extract for 90 days not only had higher levels of immune system cells, but they also had fewer symptoms of cold and flu, and missed fewer workdays due to these respiratory illnesses, than a control group. At the very least, if you eat enough of it, you’ll probably keep people away from you, Mills jokes.

Although there’s probably not enough research to support taking a garlic supplement, Mills recommends that you cook with it in the colder winter months. You can make your own pasta sauce with tomatoes and garlic, since vitamin C (found in tomatoes) is itself an antioxidant that helps the immune system she says.

8. Kefir

Recent research, including a 2021 study published in Biomedicine & Pharmacotherapy, suggests that certain compounds found in fermented dairy such as kefir (which is like a thin yogurt) have anti-inflammatory properties that can help the immune system fight viral infections. The probiotics found in kefir and other fermented foods also help to calm chronic inflammation, according to Harvard Health.

“Fermented dairy is rich in probiotics, which seem to have a positive effect on the immune system,” Mills explains.

Why Fluids Matter if You Get the Flu

Whether water, electrolyte-rich beverages, broths, or green tea (see above), you really do need liquids if you’re sick with the flu. Not only is it important to fend off dehydration, staying hydrated helps you maintain enough circulating blood volume to treat infection. (Just go easy on the caffeinated sodas and coffee.) And yes, doctors say chicken soup can’t hurt, since fever can cause you to lose water as well as salt.​

Reprinted from AARP.org

Scams aren’t always high tech, and they aren’t always new. Stealing checks from the mail and “washing” them used to be a common crime but faded away over time. Now it’s back with a vengeance. In 2021, the US Postal Inspection Service (USPIS) received 33,000 reports of incidents involving mail carrier robberies and mail theft, up from 24,000 in 2019.More from the AARP Fraud Watch Network•Learn More About Fake Check Scams•How to Prevent ID Theft•Do you think you have been targeted or have fallen victim to a scam? Contact the AARP Fraud Watch Network Helpline. Call 877‍-‍908‍-‍3360.

How It Works• Residential mailboxes with the raised flag that indicates outgoing mail are a big draw for criminals since they often contain bill payments with personal checks included.•Thieves also go “fishing” inside the blue mailboxes by inserting long flexible items with adhesive on the end in hopes of pulling out checks.•Another way into mailboxes is to steal a master key from a postal worker. These “arrow keys” open multiple mailboxes and sell for between $5,000 and $10,000 on the black market.•Once they have a personal check, thieves “wash” the ink off with household chemicals and fill it out to a new recipient for whatever amount they wish. Often, they will apply super glue on the signature to keep it intact. What You Should Know• Mail theft cases used to be more prevalent on the West Coast; however, USPIS has recently seen more incidents in the eastern US, particularly around Philadelphia, New York City and Washington, DC.•Rather than cashing forged checks themselves, criminals often sell the “washed” checks through online black-market channels, with personal checks fetching around $175 a pop.•Financial institutions typically make your account whole in the case of forged checks, but the investigation could take weeks, leaving you without access to funds during that time. What You Should Do• Bring checks inside the post office for mailing, or, if you choose to deposit mail containing checks, cash or sensitive personal information in collection boxes, do so as close to the indicated pickup time as possible.•When you put outgoing mail in your mailbox, don’t put up the flag and try not to leave outgoing mail in your mailbox for long periods of time.•Keep an eye on your account balances and report any suspicious activity right away.•Sign up for Informed Delivery from the US Postal Service. It’s a free daily service that emails you a scan of what is coming in your mail. Also, place a hold on your mail when out of town.

More than 600 drugs have been linked to hearing loss and tinnitus, including over-the-counter pain relievers

It’s normal to experience hearing loss and balance issues as you get older. But before you chalk up those problems to age, experts say you should consider whether a medication could be damaging your ears.

More than 600 medicines have been linked to hearing loss, ringing in the ear (tinnitus) or balance problems. The list of so-called “ototoxic” drugs includes both over-the-counter and prescription options. Among them: medications that treat heart problems, pain, infections and more.

In some cases, the hearing problems caused by a medication is reversible and will go away when you stop taking it, says Lawrence Lustig, an otolaryngologist at New York-Presbyterian/Columbia University Irving Medical Center.

But some drugs can cause permanent damage.

Older patients are especially vulnerable because their kidneys often aren’t as efficient at flushing out medications, putting them at higher risk of toxicity if a drug builds up in their system, Lustig says. Adults age 65-plus are also more likely to be taking more than one drug at a time and sometimes the combined effect of two medications can be worse than a drug on its own.

3 Ways to Protect Yourself

1. Ask about side effects. Ask your health care provider if hearing loss or tinnitus is a side effect of any of your prescriptions or over-the-counter medications.
2. Recognize early signs of trouble. Ringing or buzzing in your ears — or worsening tinnitus if you already have it — is often the first sign that a medication could be harming your hearing.
3. Opt for nondrug alternatives. Instead of reaching for a pain reliever for your bad back or bum knee, consider trying physical therapy, yoga or acupuncture.

Before starting a medicine classified as ototoxic, Lustig recommends getting a baseline hearing test and balance assessment, and then going for regular testing during treatment. That can help you and your doctor identify any hearing-related side effects early, since medicines often impact high frequency hearing first, so you might not notice the change without a hearing test.

Here are some common medications linked to hearing loss and what you need to know about this potentially life-altering side effect.

1. Over-the-counter pain relievers

Because painkillers such as aspirin, acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil and Motrin are widely available without a prescription, many patients take them regularly and assume that they are harmless. In fact, about 1 in 3 Americans takes a store-bought pain medication every day, according to a 2022 survey.

However, research indicates that over-the-counter pain relievers can contribute to both hearing loss and tinnitus, especially if they’re used for two or more days per week, says Sharon Curhan, an epidemiologist at Brigham and Women’s Hospital and Harvard Medical School and author of several studies on the connection.

In a 2012 study that followed more than 62,000 women, Curhan discovered that frequent use of acetaminophen or NSAIDs, even in typical doses, was linked to an up to 24 percent higher risk of developing hearing loss.  In men, a similar study demonstrated that regular use — two or more times per week — of acetaminophen, NSAIDs and aspirin are all associated with a higher risk of hearing loss.

Another large study, the Epidemiology of Hearing Loss Study, found that among adults who already had hearing loss, NSAID use was associated with a 45 percent higher risk of progression of their hearing loss.

Researchers speculate that the medications may reduce blood flow to the cochlea, an organ in the inner ear that helps with hearing.

“The overarching message from these findings is that even though these analgesics are widely available without a prescription, these are still medications and there are potential side effects,” Curhan says. “For anyone who is considering taking these types of medications regularly, it is advisable to consult with a health-care professional to discuss the risks and benefits and to explore whether there are alternatives to using medication.”

Fortunately, frequent use of low-dose aspirin (100 mg or less) has not been linked to hearing-related side effects. Many older adults take a low dose of the drug daily to prevent cardiovascular disease.

2. Aminoglycoside antibiotics

Some of the most damaging medications to hearing are a class of antibiotics called aminoglycosides, Lustig says. Available in pill form, as well as intravenously, they are believed to damage the sensory cells inside your ear needed for balance and hearing.

One aminoglycoside, called gentamicin, is often administered intravenously in the hospital to fight severe bacterial infections, such as a bone or an organ infection. Other drugs in the class also include “micin” or “mycin” at the end, such as streptomycin, neomycin, kanamycin and tobramycin.

Studies show more than 50 percent of patients who require multiple rounds of intravenous aminoglycosides may experience hearing loss. Even at recommended dosages, taking them “can result in rapid, profound, and irreversible hearing loss,” according to one review study. That study’s authors found that a single dose can result in permanent hearing loss in patients with a certain genetic mutation.

Despite the risks, these antibiotics are sometimes needed to treat what can be a life-threatening infection, says Wendi D. Jones, a pharmacist with AspenRX Health in Washington, North Carolina.

If your doctor prescribes an aminoglycoside, your health care provider should do concurrent blood testing to ensure the drug levels in your blood don’t get too high, Jones says. They should also monitor you for hearing-related side effects.

3. Loop diuretics

Loop diuretics are powerful medications that are used to treat high blood pressure and fluid retention due to heart failure, liver disease or kidney disease. The most commonly used loop diuretics are Lasix (furosemide), Bumex (bumetanide) and Demadex (torsemide).  

Experts believe these medications interfere with the ionic composition of the fluids in the ear, contributing to hearing loss. Although loop diuretics can cause permanent damage if you get a large dose by injection in the hospital, in most cases, they cause only temporary hearing loss that clears up once you stop using the drug.

“Using the lowest dose that will effectively treat the condition helps prevent ototoxicity,” Curhan notes.

If you already have hearing or balance problems, you might want to ask your doctor if a different type of diuretic would be a better choice for you.

4. Some chemotherapy drugs

Platinum-based chemotherapy drugs such as cisplatin and carboplatin are used to treat many types of cancer, including lung, reproductive, head and neck cancers.

However, they can cause permanent hearing loss, tinnitus and balance problems.

Because the drugs can be lifesaving, health care providers have to balance the pros and cons when deciding about treatment. “If a patient has to have it for a life-threatening condition, you give it to them,” Lustig says.

Scientists are working to develop medications and treatment protocols to help protect hearing while a patient is being treated with the drugs.  

5. Long-term hormone therapy

Hormone therapy can be helpful for treating menopausal symptoms such as hot flashes, but a large study led by Curhan and published in the Menopause in 2017 found a strong correlation between oral hormone therapy and hearing loss. The study, which followed almost 81,000 postmenopausal women for more than 20 years, found that the longer a woman took hormone therapy (estrogen therapy or estrogen plus progestogen therapy), the greater her risk of hearing loss.

Compared to those who never took hormones, the risk of hearing loss was 15 percent higher among women who used oral hormone therapy for five to nearly 10 years and 21 percent higher among women who used the therapy for 10 years or longer, the study showed.

Based on those results, Curhan recommends that women concerned about hearing limit their use of hormone therapy to five years or less.

6. Quinine, chloroquine and hydroxychloroquine

Quinine, a therapy to prevent and treat malaria, has long been known to cause temporary hearing loss, especially if given in large doses. Quinine is also sometimes prescribed off label to treat nocturnal leg cramps.

Two similar drugs, chloroquine and hydroxychloroquine, are also used to treat malaria and are sometimes prescribed for autoimmune diseases such as Lupus. Both chloroquine and hydroxychloroquine were investigated as possible treatments for COVID-19 infection.

Although all three drugs have been linked to temporary hearing loss and tinnitus, fortunately most patients find the hearing problems go away once they stop the medication.

Signs a Drug May be Harming Your Hearing

Just because a medication has been tied to hearing problems doesn’t necessarily mean you need to worry.

The severity and extent of the damage, if any, depends on many factors, including the dosage, how long you have been taking it, how often you take it, your kidney function, what other drugs you take, your age, if you’re dehydrated and even your genetic susceptibility, Lustig and Curhan say.

Contact a health care provider if you experience any of these signs that a medication could be harming your hearing:

• A ringing, roaring or buzzing sound in one or both ears or in your head (tinnitus)
• Worsening of existing tinnitus or you notice a new sound
• A feeling of fullness or pressure in your ears (that isn’t due to an infection)
• New onset of hearing loss or worsening of existing hearing loss
• Vertigo or a spinning sensation, which sometimes can be accompanied by nausea

If you’re concerned, it’s important to consult to your health care provider before you make any changes to your medications, Curhan says. “Together, you can evaluate the risks and benefits and explore possible alternatives,” she says. 

Reprinted from AARP.

Important: Updated COVID-19 vaccines are now available to provide increased protection against the currently circulating Omicron BA.4 and BA.5 subvariants.

If it has been at least 2 months since you completed your COVID-19 primary series or had your last booster, then you are eligible for an updated vaccine. 

As with other diseases, you’re protected best from COVID-19 when you stay up to date with the recommended vaccines. COVID-19 vaccines are effective at protecting people from getting seriously ill.

Symptoms can be subtle, but that doesn’t mean they’re any less dangerous

Despite its depiction in the movies, a heart attack doesn’t always produce pain or pressure so intense it causes a person to clutch their chest and collapse to the floor. Most people who have a heart attack experience a much less dramatic version. And some have no symptoms at all — or symptoms that are so subtle they’re mistaken for something else entirely.

These so-called silent heart attacks account for about 20 percent of all heart attacks, according to 2022 statistics from the American Heart Association. Some experts estimate that percentage is even higher — closer to 50 percent.

What is a silent heart attack?

A heart attack happens when the arteries that carry blood to the heart become blocked, thereby depriving the heart muscle of oxygen and nutrients. If a person having a heart attack feels pain or pressure, it’s because of this blockage, says Eduardo Marban, M.D., executive director of the Smidt Heart Institute at Cedars-Sinai Medical Center in Los Angeles.

The same thing happens during a silent heart attack — blocked arteries make it so that oxygen-rich blood can’t reach the heart. The only difference is the problem goes unnoticed. “It’s not necessarily that there were no symptoms; it may just be that the patient didn’t recognize them as heart symptoms and wasn’t concerned,” Marban says.

Symptoms of a silent heart attack

Few people actually exhibit no symptoms. But signs of a heart attack can be muted or confused with other conditions. Here’s what to look out for:

1. Shortness of breath
2. Weakness or fatigue
3. A general feeling of unease or discomfort
4. Sweating
5. Nausea or vomiting
6. Lightheadedness or dizziness
7. Mild pain in the throat or chest
8. Pain in the back or arms, like a sprained or pulled muscle

For example, it’s not uncommon for silent heart attacks to be written off as indigestion, a sprained or strained muscle, fatigue or “just feeling run-down,” Marban says.

People who later realize they’ve had a silent heart attack may also recall experiencing shortness of breath at the time, or a general state of discomfort that led to a night of lost sleep, says Robert Lager, M.D., an interventional cardiologist at MedStar Washington Hospital Center in Washington, D.C. Nausea, sweating, dizziness and an overall feeling of unease are also signs of a silent heart attack.

If you experience any of these symptoms, “don’t sit around and wonder” what could be wrong. “Time is muscle,” Lager says, referring to the damage that decreased blood flow can inflict on the heart. “The longer one waits to get evaluated, the more likely that there will be irreversible damage.”

That said, some people truly experience no symptoms — understated or otherwise — when they have a heart attack. Diabetics who have nerve issues that interfere with pain signals (called neuropathy), for example, are at higher risk for having a literal silent heart attack, Lager says. Women and older adults are also more likely to have an event without warning signs.

Is it a heart attack … or something else?

Silent heart attacks don’t just fool patients; they can be misdiagnosed in health care settings too. Shortness of breath may be mistaken for a pulmonary problem, for instance. And pain in the shoulder or arm can be misdiagnosed as an orthopedic issue. “So there are lots of different forms of symptoms that are referred pain from the heart that can be very confusing and sometimes can be misleading,” Lager says.

One way to tell if the symptoms you’re experiencing are due to a heart attack or another condition is to know that the warning signs of heart trouble are “not positional,” Lager says. This means that the sprain-like pain in your neck and arm won’t get better if you stretch it or shake it out. And shortness of breath or sweating won’t subside if you take it easy and lie down.

“That’s a really good rule of thumb,” Lager says. “If you’re not sure if you’re having a symptom, see if you can manipulate it in some way. Can you press on the chest? Can you change your position? Can you stand up or sit down? Does it make a difference, positionally? Because the heart has no gyroscope; it doesn’t know where it is in space. And it doesn’t matter if you put the heart upside down or right side up, it’s going to give you the same signals if it’s in trouble.”

Another thing to keep in mind: Any symptom that results from the loss of oxygen to the heart will generally get worse if you increase demand on the heart. “So if someone has chest discomfort at rest and gets up and walks around, you’re increasing the heart’s demand for oxygen, so the symptoms usually will get worse if it’s a heart issue,” Lager says.

The risks factors for silent heart attacks are the same as those for a heart attack with symptoms. The most common include:

• Age (for men, 45 and older; for women, 55 and older)
• Diabetes
• Excess weight
• High blood pressure
• High cholesterol
• Lack of exercise
• Prior heart attack
• Tobacco use
• A family history of heart disease

The dangers of having a heart attack and not knowing

Many people who have had a silent heart attack find out about it after the fact — sometimes months or years later — usually during a routine electrocardiogram, or EKG. Symptoms that arise afterward can also bring patients in to see a health care provider. Lager says people who have suffered a silent heart attack may notice a faster heart rate or increased exercise intolerance, for example.

Usually when someone finds out they’ve had a silent heart attack, the damage has already been done. But identifying a past heart attack can help you and your doctor mitigate risks for future cardiac events. After all, a silent heart attack is associated with an increased risk of heart failure, a 2018 study in the Journal of the American College of Cardiology found. It just needs to be on the name of the journal.. It also increases the likelihood of sudden death, stroke and having another heart attack.

Dangerous heart arrhythmias are another concern your doctor may monitor for if you had an undetected heart attack in the past. These can develop when parts of the heart muscle are scarred from the loss of blood. And another worry: Because “our blood gets thicker under stress,” Lager says, blood clots are also more likely to crop up after you’ve had a heart attack.

“Once the diagnosis is made, either of a recognized heart attack or a silent heart attack, everything is put into a higher risk category in terms of the complications that can ensue,” Marban says. “So it’s not something that we should just consider a curiosity and do nothing about. … Detecting a heart attack and acknowledging it is the first step towards putting the patient back on the kind of effective therapy that we know is helpful.”

Don’t ignore out-of-the-blue issues

The take-home message, Lager says, is to pay attention to a change in patterns in your body.

“If you’re someone who occasionally has some chest discomfort that’s mild, transient and occurs in certain predictable patterns, then it’s not nearly the same as someone who has new symptoms never felt before,” he says.

And if you’re prone to indigestion and just ate a spicy meal, the burning feeling in your chest is likely heartburn. But if it comes on out of the blue and the symptoms get worse, especially as you walk around or exercise, “that’s a real warning sign that it’s not gastrointestinal,” Lager says.

Reprinted from AARP.

With 228 million licensed drivers in the United States, nearly all of us will interact with our state’s Department of Motor Vehicles, or DMV (although your state may call it something different). Unfortunately, government impostor scammers know this and are shifting DMV scams into high gear for their own financial benefit.

How It Works •A text message from your state’s DMV requests payment for an overdue fee and threatens license suspension if you do not pay immediately.•Alternatively, the message may say you are due for a refund from an overpayment or — this is especially timely — it may say you are entitled to a fuel rebate to offset high gas prices.•A web search for your state DMV lands you on what you think is your state’s official DMV site. What You Should Know •In some states, DMVs do send text messages, but only to consumers who have signed up to receive them.•At any rate, government agencies, including the DMV, will not ask for personal or private data by text message.•Criminals buy online ads to lead web searchers to fake DMV pages with the goal of capturing a payment method or sensitive data that can be used for identity fraud. What You Should Do •Carefully scrutinize DMV text messages for misspellings or unusual grammar.•Avoid clicking any links in an unsolicited text message or email, even if it claims to be a government agency.•Know your state motor vehicle office’s correct name. Crooks often use the generic “DMV” in scam messages, even in states with different agency names, such as Massachusetts Registry of Motor Vehicles or Illinois’ Department of Driver Services.•Confirm that a DMV website is genuine by looking for a .gov suffix in the address, which every state motor vehicle agency uses (except for Wyoming).•Report DMV scams to the Federal Trade Commission, online or by calling 877‍-‍382‍-‍4357, and to your state’s consumer protection office.

What could be causing your fatigue — and how to fight it

David Levine feels tired — a lot — and laments how he rarely makes it to the end of a movie. The 68-year-old Manhattan journalist has a pretty good idea why: A night in the sleep lab showed he had borderline sleep apnea. “But certain medications I take, especially Lipitor, make me even more tired,” he says. “I went off it for two months, and I felt a lot better.”

Levine is in good company. Research suggests that fatigue (or anergia, in medical lingo) runs as high as 50 percent in people 65 and older, compared with rates in the general population, which range from 10 to 25 percent.

Yet “fatigue is not a natural consequence of aging,” says Barbara Resnick, codirector of the Biology and Behavior Across the Lifespan Organized Research Center at the University of Maryland School of Nursing.  “It’s more related to the changes that occur due to age and commonly associated diseases.”

Fatigue is common when you’re fighting any kind of illness, from infections to autoimmune disorders. Some treatments, such as chemotherapy, are notoriously exhausting. And, of course, fatigue is also a symptom of COVID-19, although it’s usually accompanied by more telling signs like fever and chills, even in minor cases of the disease caused by the coronavirus.

Beyond that, “all of us feel tired some of the time,” says Suzanne Salamon, M.D., assistant professor of geriatric medicine and primary care at Beth Israel Deaconess Medical Center in Boston. “Usually, it goes away, either with sleep or time.”

But if unexplained fatigue continues for more than a few weeks, it’s time to figure out what’s causing it. Here are some of the likely suspects (keep in mind, though, that more than one culprit may be responsible).

1. Your medications are sapping your energy

“Older adults take a lot of medications, and a lot of those medications tend to make people feel tired,” explains Brenda Windemuth, director of the Adult Gerontology Primary Care Nurse Practitioner Program at the University of Maryland School of Nursing. Chief among these: certain antidepressants, antianxiety drugs, sedatives, antihistamines, steroids, and blood pressure and cholesterol medications.

Antipsychotics, pain meds, seizure drugs and chemotherapy also stir up trouble. Others, like diuretics, contribute to exhaustion by disturbing your sleep. 

“Not all drugs cause the same effects in all people,” Salamon says. “If a person has started a new medicine and they notice fatigue, they should report this to the doctor. Sometimes just moving the drug to the evening or lowering the dose can help, but sometimes you need to change to a different medicine.” She recommends always bringing all your medicines — prescription and over the counter — to your office visits so your doctor can check doses and duplicates.

Levine was able to take a lower dose of his cholesterol drug and still get its benefits. Although he still feels somewhat tired, he’s decided to stay on it. “The trade-off is worth it,” he says. “I’m a tennis player and I don’t want to drop dead on the court.”

2. Your sleep hygiene may need improvement 

Many of us simply aren’t getting enough slumber and are paying the price the next day.

Poor sleep habits are often to blame. If you’re lying in bed and can’t fall asleep, Resnick advises, get up and do something until you feel tired, and then go back and try again. “The other really big mistake people make is that they expect to lie around all day and then be able to sleep at night,” she observes. “You only want to spend time in bed when it’s sleep time. Some people like to control the world from their bed.”

Other advice: Maintain a regular sleep pattern, and avoid alcohol at night. Consider keeping a sleep diary to help you identify factors — foods, drinks, medicines — that may be keeping you from solid slumber. Keep in mind that as you get older you may not require the seven to nine hours you used to, Windemuth says.

Obstructive sleep apnea is another culprit. Patients experience as many as 30 awakenings an hour when the soft tissues of the throat relax and obstruct the airway during sleep; as a result, they feel exhausted the next day.

Loud snoring is a clue. Spending the night in a sleep lab can confirm the diagnosis. The standard treatment, a continuous positive air pressure (CPAP) machine, involves wearing a mask over the nose to force air into the throat and keep the airways open.

3. You’re missing key nutrients 

People over 50 are more likely to experience nutrient deficiencies — especially vitamins B12 and D, iron and folic acid — that cause fatigue. If your doctor suspects a deficiency, she’ll send you for a blood test, and you may need a supplement. 

4. You’re anemic

This means that your blood has too few red cells or those cells have too little hemoglobin, which transports oxygen through the bloodstream. The result: fatigue.

A simple blood test provides a diagnosis, after which your physician will investigate possible reasons for the anemia and may put you on iron pills. 

There are three main reasons older adults become anemic. Kidney disease is one. If your kidneys are not working properly, they may not be able to help your body make the red blood cells it needs. “It can also be due to blood loss from somewhere, usually along the gastrointestinal tract,” Resnick says, “or it’s in the bone marrow, which could be due to a malignancy.”

5. You have a heart or pulmonary problem

Cardiac issues — including heart failure, coronary artery disease, valvular heart disease, asthma and chronic obstructive pulmonary disease (COPD) — are among the most common causes of fatigue in older people.

Heart disease can cause the heart to pump blood less efficiently and fluid to build up in the lungs. This, in turn, results in shortness of breath and less oxygen supply to the heart and lungs. So be sure to follow doctor’s orders when it comes to treatment.

6. You’re anxious or depressed

“Depression, being alone and other psychosocial issues are a huge factor in older people,” Windemuth says. “People are losing friends and spouses. They’re being uprooted from their homes or going into assisted living. That can lead to fatigue.”

Antidepressant medications are sometimes the answer. “We also encourage people to go out, become more involved and find things that they really enjoy doing,” Windemuth adds.

Paradoxically, exercise can make a huge difference. “The best thing for fatigue is physical activity — no matter what the underlying problem,” Resnick says. “The goal should be 30 minutes daily of moderate-level activity.”

Playing tennis has been a lifesaver for Levine, helping him to keep up his energy level. “If I exercise in the afternoon, I feel better,” he says.

7. COVID could be the Culprit

When COVID-19 symptoms linger long after a person’s initial illness, fatigue is a very common complaint. “Estimates of the prevalence are variable but some sources suggest that more than 50 percent of all COVID survivors are affected by persistent fatigue,” says John Baratta, M.D., founder and codirector of the UNC COVID Recovery Clinic at UNC Health in Chapel Hill, North Carolina. “In our Long COVID clinic, over 90 percent are troubled by this symptom.”

Before treating the fatigue, doctors first investigate other potential factors that may be contributing to extreme tiredness, such as sleep apnea, depression and chronic pain, says Benjamin Abramoff, M.D., head of the Post-COVID Assessment and Recovery Clinic at Penn Medicine in Philadelphia. Then you may be prescribed physical therapy or a graded exercise program, where the duration and intensity of activity is gradually increased. Both can improve stamina, but it’s important to pace yourself to avoid exacerbating symptoms or risking relapse, Baratta says.

“We have also found benefits from certain medications, such as antidepressants and stimulants, in certain situations,” Baratta adds. These include certain antidepressants in the SSRI (selective serotonin reuptake inhibitor) class and stimulants like those used to treat attention deficit disorder.

If you’re suffering from fatigue related to long COVID, ask your doctor about such strategies or consider making an appointment at a post-COVID clinic. These programs typically take a multidisciplinary approach to treating the disease’s lasting symptoms, fatigue included.

Reprinted from AARP

How to Keep Older Adults Safe in Extreme Heat

Heat waves are dangerous to everyone, but they pose an even greater risk to older adults. Here’s how to stay safe on hot summer days.

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Much of the country has been steeped in heat this month; while the South and Central regions have already seen temperatures in the triple digits, the Northeast is bracing for its own sweatfest. Boston Mayor Michelle Wu declared a heat emergency through Thursday, and officials have established cooling centers around the city as temperatures were expected to surpass 100. The whole of Arkansas, too, was expected to exceed 100 degrees, with the National Weather Service tweeting out a warning to state residents: “Wednesday will be another brutal day with very hot temperatures and dangerous heat index values. Stay safe out there.”

Meanwhile, those hoping to escape the heat wave by vacationing abroad have been out of luck. Europe is also baking, with England experiencing an unprecedented 104 degrees Fahrenheit this week, a wild jump from its average July high of about 70 F. Britain’s weather office issued a red warning, its most severe, for when “illness and death may occur among the fit and healthy, and not just in high-risk groups.”  

Take those warnings seriously: Steamy temperatures can kill.

When the heat dome descended on the Pacific Northwest last summer, Washington state had 100 heat-related deaths between June 26 and July 2, according to the state’s Department of Health, which noted that those were only confirmed cases: “We are not reporting probable heat-related deaths.” On June 28, 2021, alone 1,090 people in the Northwest U.S. visited emergency departments for heat-related illnesses (hyperthermia), the Centers for Disease Control & Prevention reports.

Older people are particularly at risk for hyperthermia during periods of extreme heat, the National Institutes of Health warns, due to factors such as poor blood circulation and reduced sweating (sometimes caused by medications for age-related illnesses).

Everyone should know about such dangers when summer weather starts scorching.

Dehydration 

We are quite literally what we drink. Our bodies are mostly (about 60 percent) water, and we can’t live more than a few days without it. There is no universally accepted rule of thumb for how much, exactly, each of us should drink, despite how often we’ve been told to consume eight 8-ounce glasses a day, or 64 ounces total. The National Academy of Medicine recommends that adult men drink about 15 cups (125 ounces) of fluid a day and women 11 cups (91 ounces), but experts say the ideal amount can vary widely depending on factors including a person’s weight, health and activity level.

By the time you’re thirsty, you’re likely to have lost around 1 or 2 percent of your body’s fluid, so a key measure of dehydration is thirst. But this warning system doesn’t always function well in older adults, says Kumar Dharmarajan, a geriatrician and chief scientific officer at San Francisco–based insurer Clover Health, who explains that as people age they are less able to perceive their own thirst, “so when they need water, they’re less likely to respond to it.” 

How to tell if you’re dehydrated 
In addition to thirst, your urine color can indicate dehydration. When urine is dark, it’s a sign that it is more concentrated due to less fluid in your body. “It should look more like lemonade, less like apple juice,” says Luke Belval, director of research at the University of Connecticut’s Korey Stringer Institute, which focuses on safety in sports. “We’re shooting for that pale, straw-colored urine.” 

Another self-evaluation Belval recommends: Weigh yourself every morning. If you find that you’ve lost a pound or two from the day before, you are probably dehydrated — apologies to dieters — “because, in general, gross changes in body mass don’t happen that quickly.” 

Signs of more severe dehydration can include a dry mouth, headache, decreased urine output, increased pulse, lack of sweat, irritability, and feeling fatigued, nauseous, lightheaded or dizzy.  
  
How to prevent dehydration 
Drink frequently throughout the day. “Rather than wait until you feel bad and drink a ton of fluid, it’s better to maintain your hydration by drinking regularly,” advises Raj Deu, M.D., assistant professor of orthopedic surgery at the Johns Hopkins University School of Medicine.

One thing preventing some people from drinking enough water, of course, is not having easy access to a bathroom. “Often they will restrict how much they drink and end up being dehydrated,” Deu observes. It can be a big problem for athletes, who may not be able to take bathroom breaks during practice or games, as well as for older men, who already may find that they need to urinate more frequently (a common issue as the prostate enlarges with age). “If you throw in drinking a ton of fluid, they’re going to be running to the bathroom an awful lot,” he says. 

There’s no great solution when bathrooms are scarce, Deu adds, but his best advice would be to try to maintain a steady hydration level, rather than drink a large amount of liquid at once.

Experts also recommend avoiding alcohol, which is dehydrating, and being careful with caffeine, a mild diuretic, which means it causes you to eliminate an increased amount of fluid from your body.

And, yes, it is possible to drink too much water. Hyponatremia occurs when you drink so much fluid that you dilute the sodium level in your blood, which can lead to severe medical problems or death. But it’s rare, being associated most often with marathon runners who guzzle water repeatedly along their route without periodically urinating.  

Heat Exhaustion and Heatstroke

Heat can make you sick — and can quickly become life-threatening. The milder problem is heat exhaustion, which occurs when your internal body temperature begins rising too high. You may experience sudden fatigue and dizziness as your blood pressure rises, and some people experience a change in mood — symptoms that shouldn’t be taken lightly but that can usually be addressed without medical intervention. 

The University of Connecticut’s Belval says, “Generally, if you bring the person into the shade, elevate their legs and give them some water to drink, they recover pretty quickly.” (Elevating the individual’s legs helps blood pressure to normalize.)

Heatstroke, however, is a true medical emergency, and if not treated quickly, it can lead to death. It’s heatstroke when a person’s body temperature gets so high — typically more than 104.5 or 105 degrees — that the organs shut down and the person can become unconscious. If you’re assisting someone in this situation, call 911, Belval says, and “cool the person down as quickly as possible, covering their body with as much ice water as you can.”

Heatstroke can occur in high heat with heavy exertion (a 30-year-old man running a race in New York state in the heat reportedly died after his body temperature reached 108 degrees) or more gradually, after days spent in a hot environment — for example, someone who’s stuck at home alone without air-conditioning during a heat wave.

Along with, and partly because of, their higher risk of dehydration, older people are more susceptible to such heat-related illnesses, Dharmarajan explains. Older adults don’t sweat as easily as younger people and are “less able to dilate the blood vessels in their skin to emit heat from their bodies” to cool themselves down. 

Older people also may have medical conditions or be taking medications (such as diuretics) that can impair a body’s ability to regulate heat, says Dharmarajan: “It sort of can be like a double whammy because the medication is pushing the body in one direction but so is the sun and the heat.”

How to prevent heat-related illnesses

1. Wear light, loose-fitting clothing that allows the body to breathe. 
2. Drink plenty of water, and avoid alcohol and caffeine. If you’re going to be exercising in the heat, sip water throughout your workout and consider bringing a damp towel packed in ice to cool yourself off.  
3. Spend as much time as possible in air-conditioned spaces. If you don’t have air-conditioning at home, go to cool public places like libraries. “A fan isn’t going to cut it if it’s really hot,”
4. Stay out of middle-of-the-day heat and use sunscreen; sunburn can cause dehydration and a diminished sweating response, says Belval.
5. As soon as you start feeling tired and short of breath, stop, rest and hydrate. 

Reprinted from AARP.

You’ve had it with relentless robocalls, the automated messages that at best are telemarketing and at worst are pitches from criminals who want to steal your cash or your identity.

Enough is enough with the deluge of unsolicited voice mails and the calls from phone numbers that look like they’re local but are spoofed (or disguised) by crooks who claim to be with the IRS or to have important information about your car warranty.

You’ve tried blocking numbers, to no avail. You’ve signed up on the National Do Not Call Registry. No difference. You’ve complained to the Federal Trade Commission (FTC) and the Federal Communications Commission (FCC). Nada.

Scam calls rebound from COVID crash

When the coronavirus pandemic erupted in early 2020, “we saw the first major drop in robocalls because call centers were closed, but now robocalls are exploding,” says Alex Quilici, CEO of YouMail, which develops robocall-blocking software.

Robocall volume in the U.S. hit an estimated 5.7 billion calls — an all-time high — in October 2019, then sank to about 3 billion a month in the spring of 2020, according to YouMail’s Robocall Index. 

Spammers and scammers have since rebounded, with robocalls averaging 4.1 billion a month over the past year. That’s more than 1,500 calls per second.

“Having computers dialing a bunch of numbers is a fast, efficient and extremely cheap way to get to as many people as possible,” Quilici says, adding that scammers need only a tiny slice of call recipients to respond for their endeavors to pay off.

Some robocalls are legal

Amid the din, some robocalls are legitimate. Charities, pollsters and medical-service providers are among those who can legally autodial you. The American Red Cross can robocall you to ask for blood donations, for example, and your doctor’s office may do so to remind you of an appointment.

But when it comes to bad actors, keep in mind that mobile apps can beat them back. Also, importantly, the FCC now requires voice-service providers to implement call-authentication technology on the Internet Protocol (IP) portions of their networks. 

The James Bond–sounding “STIR/SHAKEN” authentication enables providers to verify that the caller ID information transmitted matches the caller’s real phone number. This anti-spoofing step was mandated by the federal TRACED (Telephone Robocall Abuse Criminal Enforcement and Deterrence) Act, an AARP-endorsed measure signed into law at the end of 2019.

A united front

On the corporate side, the trade group USTelecom established the Industry Traceback Group to identify the sources of illegal robocalls and work with governments to “bring to justice individuals and entities responsible,” says Patrick Halley, USTelecom’s senior vice president of policy and advocacy. 

The source of an illegal robocall — even one from outside the U.S. — often can be identified in 24 hours, Halley says. While billions of illegal and unwanted robocalls are still placed annually, fewer of them are reaching consumers, thanks to call-authentication, call-blocking and call-labeling tools that designate incoming calls as spam, he says.

For example, AT&T, the largest U.S. carrier, says it is blocking more than 1 billion robocalls a month.

Best practices for consumers

To join in the fight, consumers are urged to:

• Download a call blocker. First, try a free solution to see if it does the trick. No-cost services from firms such as YouMail and Nomorobo are carrier-agnostic. (Nomorobo is free for landlines but $1.99 a month for cellphones.) Your mobile carrier has free tools, too.
  
• Experiment with call-blocking tools, apps and options, to strike the right balance between the calls you want and those you don’t. It may take trial and error to avoid a “false positive,” the term for a legitimate call that is stopped.
  
• Let a call go to voice mail if it gets through a robocall app and you don’t recognize the caller. If the caller claims to be from, say, Citibank, don’t call back a number left on voice mail. Use a number that you know is legitimate, such as one on a statement or credit card.
  
• Hang up if it’s a live person calling, as computer-based robocall systems allow. Do not engage.
  
• Learn what security tools your provider offers. See Help for consumers, below.
• Heed the latest advice from the FTC and the FCC.

https://imasdk.googleapis.com/js/core/bridge3.521.0_en.html#goog_987922511Play Video

Avoid Illegal Robocalls With 4 Easy Tricks

Help for consumers

AARP asked the three dominant wireless companies what they are offering. Here’s a summary.

AT&T

• AT&T Call Protect blocks all known fraud calls outright, while suspected spam is labeled so users can choose whether to answer. The company says it blocks or labels about 1 billion robocalls a month.
  
• For a fee, users can download an advanced version of the Call Protect app that includes caller ID and allows users to block, allow or send certain call types to voicemail.
  
• The company’s fraud team uses machine learning to identify suspicious call patterns and prevent illegal calls.
  
• AT&T uses automated scanning to identify and help block spam. 

T-Mobile

• T-Mobile and Sprint cellular plans include Scam Shield, a free set of tools that alerts users when a call is likely a scam and blocks calls the network considers to be more serious threats.
  
• Its plans now include free caller ID.
  
• Customers receive a free “proxy telephone number,” a second number to give out when looking to keep one’s main number private.
  
• Customers are allowed a free number change if their current one becomes a magnet for excessive spam calls.

Verizon

• Verizon says it has blocked more than 20 billion unwanted calls to date using tools such as Call Filter, a free app available to most customers that automatically blocks calls the company determines are likely fraudulent.
  
• Call Filter Plus, which costs $2.99 a month, allows users to create a list of numbers to block. It also includes caller ID, access to a database of 100 million known spam callers, and a visual spam risk meter.
  
• Verizon has created fake “honeypot” lines to track illegal robocall campaigns and notify law enforcement, says spokeswoman Kate Jay. As of late 2021, the lines had revealed more than 250,000 scams, Jay says.

Reprinted from AARP.org